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INSTRUCTIONS FOR THE DOCTOR

This is a long case.

Please take a history from your patient, Kathy Jones, and request the findings of an appropriate physical examination. The facilitator will give you the results of any relevant investigations on request. Then negotiate a management plan with Kathy.

Scenario

Kathy Jones is a 55-year-old woman who has been attending your practice for several years. She is mostly healthy but has hypertension and dyslipidaemia, which are well-controlled with telmisartan and atorvastatin. She is married with three grown children and works as a school librarian. She went through menopause about five years ago and found some relief from her hot flushes with some over-the-counter natural remedies. She is quite health conscious, enjoys a good diet and remains physically active.

The following information is on her summary sheet:

  • Past medical history

  • Hypertension

  • Dyslipidaemia

  • Medication

  • Telmisartan 40 mg od

  • Atorvastatin 20 mg od

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Lives with husband

  • Non-smoker

  • Alcohol—one to two units on rare special occasions.

INSTRUCTIONS FOR THE PATIENT, KATHY JONES

You are coming to the doctor because of three to four months of tiredness. Your fitness is OK and your interest is fine; you just feel lethargic. Your mood is good and you remain active in your work and various interests. You’ve never felt like this before and have no idea what could be going on. You have not had any cold or flu symptoms apart from some vague aching of your joints—mainly the hands and wrists—over the past couple of months. You have taken some paracetamol when your joints have been sore. None of your joints are red, swollen or tender. You’ve not had a temperature, your appetite is good and your weight is stable. You sleep well and you don’t snore.

You are happily married with three grown children and four grandchildren, who are all healthy. You took some over-the-counter natural remedies for hot flushes when you went through menopause about five years ago. You still have some issues with vaginal dryness and your libido has been low in recent months.

You’ve been on medication for blood pressure and to lower cholesterol for several years and you are extremely conscientious in taking these. You have no known allergies, have never smoked and are not aware of any significant family history.

Your cervical screening test, mammogram and FOBT are all up-to-date.

The following information is on your summary sheet:

  • Past medical history

  • Hypertension

  • Dyslipidaemia

  • Medication

  • Telmisartan 40 mg od

  • Atorvastatin 20 mg od

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Lives with husband

  • Non-smoker

  • Alcohol—one to two units on rare special occasions.

INFORMATION FOR THE FACILITATOR

Clinical examination findings

Please give the candidate the ...

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